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Tuesday, August 16

Gerak Khas Attachment: Day 7

Please refer glossary below

Ok. Today I came a little bit early. It had been a very congested post-active ward. I came up, putting on my stuff, comforting myself and heading to the ward. One of the HO doing ward rounds and I ask him if I can do any blood withdrawing or any procedure. Unfortunately, there is no luck with him. I wander around the ward and asking another HO. Luckily a HO, have some patient's blood still not taken.

I went to that patient, a dengue makcik in fifties, her veins is very much 'hidden' owing to the fact that this makcik is slightly obese. I opened the tourniquet and just left. After that, I got a second patient, a SLE patient, 10 cc blood is needed for this patient which should be filled in 4 plain tube, 1 FBC tube. It is a large amount of blood. Then I went to the patient with tourniquet, alcohol swab, 10 cc syringe, green needle, and cotton ball. She was on IVD in left hand, but her right hand was bruised and edematous. So, I decided a wrong decision. I TOOK THE BLOOD SAMPLE FROM THE LEFT HAND!! I asked from the other HO. She said just don't tell the other HO that asked me to do that blood sampling. Otherwise, all sample was all in good condition! heheh

After that, another Ho, asked me to take blood from a dengue patient. He is young and fair. It should be easy, but I failed the attempt. I withdraw the needle to fast, which is no need because I'm at the right place that time but I just need to reposition the needle a little bit and wait blood to come out. Then I can't do it again although pressure was applied to that site. I then realized this is a dengue patient which compulsorily presented with thrombocytopenia. I excused myself and said another doctor will come. I'm quite disappointed with that. Luckily, as soon as I came out from that room, the HO that offered me SLE patient said there is another patient that need FBC blood sample, a AE COAD patient. She was a rather skinny patient, so it was quite easy to take blood sample.

After that, I followed ward round as usual. I was asked about ascending cholangitis. Also the specialist assessing the HO skills on neuro exam. It was good because I can refresh my memory on how to do the exam.
i) We need to assess the tone then the power then the reflex.
ii) Also, all the power should be assessed group by group
iii) Remember all the motor power grading by heart!
iv) For reflex, please make sure the patient is fully relaxed
v) If reflex negative, do Jendrassik maneuver

A MO also asked me what to see in dengue patient FBC, so it is Hct, Plt, WBC.
Hct- for showing the stage of the infection
Plt- detect any hemorrhage
WBC- increase WBC show case improvement.

Then, we saw the SLE patient, the specialist asked me how to diagnos it. I said depends on criteria. But I can't recall anything but it's mnemonic. It is A RASH POInts aN MD.

1) Arthritis
2) Renal abnormality
3) Antinuclear antibody
4) Serositis (pleurisy/pericarditis or other)
5) Hematological disability
6) Photosensitivity
7) Oral ulcers
8) Immunological abnormality
9) Neurological abnormality
10) Malar rash
11) Discoid rash

We were also asked to read about MODY. There is 4 types of MODY which the most common one is MODY-2. It is caused by glucokinase deficiency. You can search about the rest, huh? I need to go to prepare home-made murtabak for my family!

Glossary

SLE- systemic lupus erethymatosus
FBC- full blood count
IVD- intravenous drip
AE COAD- acute exacerbation chronic obstructive airway disease
Hct- hematocrit
Plt- platlet
WBC- white blood cell
MODY- maturity onset diabetes in young

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